Alerting system

ABSTRACT

An alerting system for use in generating an alert in respect of usage of a device, the alerting system including a detector capable of detecting an event that is indicative of usage of the device, the alerting system being arranged to invoke a selected alert state prior to the activation of a forthcoming said event by a user, the alert state being selectable from a plurality of different alert states, wherein each of the different alert states represents a different stage of elapsed time since a previous said event, and wherein the alerting system is arranged to select an alert state in dependence on the elapsed time.

TECHNICAL FIELD

The present invention relates to an alerting system for use ingenerating an alert in respect of a forthcoming event. The inventionparticularly, but not exclusively, relates to an alerting system for usewith a medicament dispenser.

BACKGROUND TO THE INVENTION

Many conditions are treated by taking one or more drugs at regularintervals, and the success of the treatment is largely dependent on theability of the user to comply with the regimen associated with the drug.Management of regimen compliance is assisted by various remindingdevices and systems, which either generate an alarm at certain specifiedtimes or inform the user whether or not a dose is due in response to arequest for medication. For example, U.S. Pat. No. 4,419,016 disclosesan alarm system arranged to generate an alert when a next dose is due tobe taken and a time keeping system that displays the amount of timesince a last dose is deemed to have been taken. The alert is generatedon the basis of absolute time, in that, upon reaching a time that a doseis due, an alarm is generated, whilst the time keeping system merelyserves to provide information to the user. WO 02/078593 is a developmentof the system disclosed in U.S. Pat. No. 4,419,016, in that it uses thetime that medication was last taken to identify time of next dose, thatis to say it has a reminder system based on dose history informing theuser whether a dose is due or not in response to a user requesting adose.

It would be desirable to provide an improved alerting system for use ina medicament dispenser, where the generation of alerts is based on dosehistory.

SUMMARY OF THE INVENTION

According to one aspect of the present invention, there is provided analerting system for use in generating an alert in respect of usage of adevice, the alerting system including a detector capable of detecting anevent that is indicative of usage of the device, the alerting systembeing arranged to invoke a selected alert state prior to the activationof a forthcoming said event by a user, the alert state being selectablefrom a plurality of different alert states, wherein each of thedifferent alert states represents a different stage of elapsed timesince a previous said event, and wherein the alerting system is arrangedto select an alert state in dependence on the elapsed time.

In the context of medicament dispensers, an event indicative of usage ofthe device can be an event relating to the dispensing of medicament,such as movement of a refill within the medicament dispenser.Accordingly, when the alerting system is implemented in a medicamentdispenser, the detector can be provided by a sensor arranged to detectsuch refill movement.

When incorporated into a medicament dispenser, an alerting systemaccording to the invention allows the user to review the stage ofelapsed time since a previous dose—i.e. whether it is too early to takea dose (“early” stage), time to take a dose (“dose due” stage) orwhether the dose time has been missed (“late” stage)—before initiatingdispensing of the medicament.

Since the alert states are based on the amount of time that has elapsedsince medicament was last taken, the compliance of a user with aselected regimen, that is to say correlation between a time that theuser is reminded to take a dose and the time that a dose is actuallydue, can be increased. This provides an improvement over remindersgenerated at specified times, where a reminder is given irrespective ofhow appropriate (or otherwise) it is for the user to take a dose at thattime, based on the time that a dose was previously taken.

Patients are quite often mobile, and, when a dose falls due, can be somedistance (and thus time) away from the location of their drug. Forexample, a user could be located 2 hours away from his medicine; if hewere to receive an alarm in accordance with known systems, he would beunable to take the medicine for at least 2 hours. The present inventionprovides an improvement over these known systems, since the plurality ofalert states correspond to particular stages of elapsed time since thelast dose was taken (e.g. “early” “dose due” and “late”). In the contextof our user who is located 2 hours from the location of his drug, with amedicament dispenser according to the invention, the user would knowwhether the current time is “early”, “late”, etc. and accordingly canensure that his journey is started in advance of that time. Thus, incomparison with known methods, the user is able to improve the planningof his activities with respect to his dosage regime.

As with all equipment, medicament dispensers equipped with remindersystems can be expected to malfunction at certain times. In the field ofmedicine, the effects of generating, for example, reminder messages atinappropriate times, can be hazardous and potentially life-threatening.Given the seriousness of these effects, the medicament dispenseraccording to the invention leaves the decision to take a dose in thehands of the user—i.e. not issuing a single “dose due”instruction—whilst providing useful assistance in the form of a set ofalerts. In addition, by providing the user with information relating tothe stage since a previously taken dose, the user is better able tojudge whether it is appropriate or not to take a dose.

Advantageously at least one alert state represents a length of time inexcess of 2 hours, and at least one alert state preferably correspondsto a period that includes an elapsed time of 24 hours. For a once a dayregimen, this means that the medicament dispenser includes an alertstate corresponding to a “dose due” stage of elapsed time. Preferably atleast one alert state corresponds to a period that includes an elapsedtime in excess of 24 hours, thereby including an alert statecorresponding to a “late” stage of elapsed time in a once a day regimen.

Preferably, the alert states include a first alert state correspondingto a period which includes an elapsed time of 24 hours and a secondalert state corresponding to a period which includes an elapsed time of12 hours. This represents a regimen-neutral reminder system, in so faras there is one alert state corresponding to “dose due” for each of theonce and twice a day regimens.

Conveniently at least one alert state represents a different length oftime to that represented by at least one of the other alert states orthat represented by the other alert state. For example, if an alertstate were embodied as a display mode comprising two or more visibleregions, the time periods to which the regions correspond could vary;for example, for the case of a twice a day regimen, where a dose fallsdue every 12 hours, a region corresponding to an “early” stage ofelapsed time could correspond to 0-10 hours of elapsed time; a regioncorresponding to “dose due” stage of elapsed time could correspond to10-14 hours of elapsed time, and a region corresponding to “late” stageof elapsed time could correspond to 14-20 hours of elapsed time. In thisexample, the regions correspond, respectively, to 10, 4 and 6 hours.Advantageously, the respective durations of elapsed time can be drivenby the type of medicament, since some medicaments can be expected to bemore sensitive to deviations from the ideal spacing between doses thanothers.

Conveniently at least one alert state comprises a plurality ofsub-regions, each sub-region representing a proportion of elapsed timewithin the stage to which the alert state corresponds. This provides anindication of where the currently elapsed time is, in relation to aparticular stage of elapsed time, thereby providing the user with moredetailed information.

Further features and advantages of the present invention will becomeapparent from the following description of preferred embodiments of theinvention, given by way of example only, made with reference to theaccompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a perspective view of a medicament dispenser within whichan embodiment of the invention operates, with the cassette removed fromthe holder and body;

FIG. 2 a shows a plan view of the medicament dispenser of FIG. 1 withthe cassette in the non-dispensing position;

FIG. 2 b shows a plan view of the medicament dispenser of FIGS. 1 and 2a with the cassette in the dispensing position;

FIG. 3 shows a schematic view of an internal mechanism of a cassette inaccordance with an embodiment of the present invention;

FIG. 4 is a schematic block diagram of an electronic subsystem of themedicament dispenser;

FIGS. 5, 6, 7, 8 a-8 e, 9 a, 9 b, 10 a-10 d, 11 a-11 e, 12 a-12 f, 13a-13 c, 14 c-14 e, 15 a-15 d, 16 a-16 e illustrate alternative displayconfigurations showing various alert states indicating different stagesof elapsed time; and

FIGS. 14 a and 14 b are schematic diagrams showing a bezel according toa seventh embodiment of the invention, configured to engage with theholder of FIG. 1.

DETAILED DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a medicament dispenser, within which an embodiment of thepresent invention operates, in the form of a base unit comprising anouter cover 10 and a holder 20, and a refill cassette 30. In thisexample the medicament dispenser is a dry powder inhaler adapted fororal inhalation. The holder 20, which includes an electronic display 22,is shaped to fit inside cover 10 and is fixed to the body via a bearing(not shown) about which it rotates coaxially. Stops (not shown) protrudefrom the holder 20 and prevent the holder 20 from rotating more thanabout 180° relative to the cover 10. The stops also provide two definedpositions of the holder 20 within the cover 10. An outer part of theholder is shaped in the form of a concave recess 26 to provide a thumbor finger grip for the user of the device. The holder 20 forms a recessinto which the refill cassette 30 latches.

The refill cassette 30 comprises a shell containing the medicamentcarrier and a mechanism for opening the carrier for the medicament to beaccessed. The refill cassette 30 has a rear portion 32 which is exposedby a cut-away part of the holder 20 when the rest of the cassette 30 iscontained within the holder 20 so as to allow the cassette to bemanually gripped for removal from the holder 20.

The refill cassette 30 also has a mouthpiece 36 from which a userinhales medicament dispensed from the cassette 30.

FIG. 2 a shows the medicament dispenser with the cassette 30 in place inthe holder 20 and with cover 10 in a non-dispensing position in whichthe rear end 32 of the cassette is exposed. The cassette 30 is fixed inplace by a spring-biased catch (not shown). When the cassette 30 is inthe position shown, relative to the holder 20, the cover 10 covers themouthpiece (not shown). The cover 10 also protects the thumbtab 28 of anindexing lever (not shown) and this prevents accidental indexing of themedicament carrier when the medicament dispenser is not in use.

FIG. 2 b shows the medicament dispenser of FIGS. 1 and 2 a with thecassette 30 in place in the holder 20 in a dispensing position. Theholder 20 has been rotated relative to the cover 10 so that a stop onthe holder 20 abuts the cover 10. It can be seen that the holder 20 hasa further cut away portion to expose the mouthpiece 36.

FIG. 3 schematically shows an internal mechanism of a refill cassette 30containing a medicament carrier, in the situation where the majority ofthe pockets are still filled with discrete doses of medicament in theform of dry powder. The internal mechanism comprises an index wheel 60and a lid-winding wheel 70 for winding the used portion of the lid sheet58. The index wheel 60 has a plurality of recesses 62 a, 62 b extendingparallel with the axis of the wheel. The recesses 62 a, 62 b are spacedat a pitch which is equal to the distance between the centre lines ofadjacent pockets 54 a, 54 b.

The cassette 30 also includes an area 80 for the medicament carrier tobe coiled up prior to use of the doses contained inside it and an area82 where the used base of the medicament carrier is collected. Area 82contains base winding wheel 86 on which the used portion of the basesheet is wound, and a spindle mechanism (not shown) is arranged tounidirectionally rotate the index wheel 60 and the lid-winding wheel 70in unison with base winding wheel 86.

In operation, the user moves the holder relative to the body to move thecassette into the dispensing position and then presses on the finger tabof the lever to cause it to move. This leads to rotation of the indexwheel 60 which results in rotation of both the base winding wheel 86 andthe lid winding wheel 70, thus peeling the base sheet and lid sheetapart over a distance sufficient to expose a previously unopened pocketopposite the end of the powder outlet. The patient can then inhale thepowdered medicament through the mouthpiece.

FIG. 2 b shows the thumbtab 28 of the indexing lever in a resetposition, ready for actuation. Actuation of the thumbtab 28 indexes themedicament carrier within the refill cassette 30, thereby exposing adose of medicament ready for inhalation through the mouthpiece 36. Thedisplay 22 shown in FIG. 2 b includes a graphical representation of aset of indicia representative of time elapsed and a set of dose countindicia, to be described in further detail below.

Embodiments of the invention are concerned with aspects of alertingsystems, and in particular, with aspects that can be usefully employedby medicament reminder systems. In the context of medicament remindersystems, embodiments are concerned with improving a user's compliancewith a preferred regimen, that is to say the correlation between thetime that a user actually dispenses medicament and the time that themedicament should be dispensed.

In embodiments of the invention, an alert state is generated based onthe time that has elapsed since a previous event, so that the alertstate provides the user with information that enables them to ascertainthe stage, in relation to the time of the next event, to which thecurrent time corresponds. In the context of medicament dispensers, anevent comprises taking a dose of medicament, so that the alert stateprovides the user with information that enables them to ascertain thestage, in relation to the time of the next scheduled dose, to which thecurrent time corresponds. In one embodiment, the stages include “early”or “due” or “late”. The alert states are presented proactively, prior tothe activation of a next event relating to the dispensing of medicament.Thus an alert state can be presented at a time that corresponds to an“early”, “due” or “late” stage of elapsed time.

Various embodiments of the invention, integrated with a medicamentdispenser, will now be described in more detail.

FIG. 4 is a schematic block diagram of the electronic subsystem of themedicament dispenser. The holder 20 includes an in-built control unit90, for example in the form of a microprocessor chip, including aninternal clock. Various sensors are electrically connected to thecontrol unit 90, including a battery voltage sensor 92, which monitors,against a threshold, voltage of a battery providing electrical power tothe medicament dispenser, also housed in the holder 20. In somearrangements, the control unit 90 can include a cover open sensor 94,which senses movement of the cover relative to the holder from thenon-dispensing position, in which the cover covers the mouthpiece of thedispenser, to an open position in which medicament may be dispensed.

The control unit 90 also includes means for detecting that a dose hasbeen taken; in a first arrangement the means comprises dose sensor 107,which is part of the refill cassette 30. The dose sensor 107 is in datacommunication with the control unit 90 via a data communicationinterface 110, which uses a transceiver in the control unit 90 and atransceiver in the sensor 107. When the index wheel 60 is rotated, thedose sensor 107 senses said rotation, and transmits a signal to thecontrol unit 90 indicating that a dose is about to be taken (theassumption being that a dose will subsequently be taken). In a secondarrangement the means for detecting that a dose has been taken isprovided by a radiation emitter 104, which emits radiation into themouthpiece, and inhalation sensor 106, which detects the emittedradiation on the other side of the mouthpiece. When the user inhales,the medicament powder causing scattering of the radiation emitted byradiation emitter 104, thereby reducing the detected level of radiationat inhalation sensor 106, indicating the inhalation of a dose. Thecontrol unit 90 and base unit comprise fewer components in the firstarrangement, and is the preferred arrangement. The control unit 90 isoperatively connected to the display 22, for controlling the display inaccordance with an alert state.

Various different conditions of the medicament dispenser may be sensedby means of the electronic subsystem illustrated in FIG. 4. Theseinclude the stage of elapsed time since a previous dose was dispensed;after a dose is dispensed and/or inhaled, the control unit 90 begins atime elapsed function, which monitors time that has elapsed since a dosewas sensed to have been taken. This elapsed time is used by the controlunit 90 to select an alert state, which is displayed on the display 22.Thus in this embodiment the alerting system is provided by the controlunit 90.

Each of FIGS. 5-16 shows alternative embodiments of screen configurationfor the display 22, whereby the alert states may be indicated to theuser. In at least one embodiment each of the alert states is embodied asa display mode and presented on a segmented LCD display. Note that,below, the description of elements of each of the screen configurationsis to be understood to apply to the same indicia displayed in each ofthe different screen configurations where the same numerical references,incremented by multiples of 100, are used. Although the exact form ofthe indicia are different, their functions and the control thereof bythe control unit 90 are similar and therefore should be understood thatthe description in relation to indicia in one configuration appliesequally to similarly referenced indicia in different configurations.

Referring firstly to FIG. 5, in a first embodiment the displayconfiguration 22 comprises dose count indicia 500 and a display mode 502having one or more separately activatable regions 501 a . . . 501 l,which for example each separately indicates a further period that haselapsed since the time of last taking a dose. Each display mode thuscorresponds to a particular arrangement of regions and, since thedisplay mode changes in accordance with increasing elapsed time, thedisplay mode indicates the stage of elapsed time. In this configuration,each region corresponds to a period of 1 hour.

FIG. 6 shows an alternative arrangement, where the activatable regions601 a . . . 601 l are positioned around the periphery of the display 22,and FIG. 7 shows a yet further alternative arrangement, where eachactivatable region 701 a . . . 701 l corresponds to 2 hours and forms asegment of a circle.

Referring now to FIGS. 8 a-8 e, a second embodiment will be describedfor the case where a dose should be taken every 24 hours (hereinreferred to as a “once a day regimen”). In this embodiment there arethree display modes, a first displaying early activatable region 801 a(FIG. 8 a), a second displaying due activatable region 801 b (FIG. 8 b)and a third displaying late activatable region 801 c (FIG. 8 c). In thefigures, these regions 801 a, 801 b, 801 c are assigned differentpatterns (dots, stripes, bricks respectively) to aid identification of aparticular region, and the words “early”, “due” and “late”, whichexplicitly define the different stages, are shown on the Figures forclarity only (that is to say that the screen 22 would preferably notdisplay the text). Preferably each region 801 a, 801 b, 801 c would havea different colour, and the user would be informed which colour relatesto the different stages. As an alternative to a display mode displayinga single region corresponding to the current stage of elapsed time, eachdisplay mode could display regions indicative of current and previousstages. Thus, referring to FIGS. 8 d and 8 e, both the “early” region801 a and the “due” region 801 b are shown when the elapsed time fallswithin the “due” region, and, when the elapsed time falls within the“late” region, all three regions 801 a, 801 b, 801 c are shown. Thearrangement shown in FIGS. 8 d, 8 e has the advantage of allowing theuser to track his progress through the various stages, and means that hedoes not have to remember which region refers to which stage: if thereare three regions in total and only two are displayed, the currentlyelapsed time must correspond to the “due” stage.

A particular feature of this embodiment is that the regions correspondto periods of different lengths, and it may be expected that the lengthswill be dependent on the sensitivity to deviation from a strict 24 hourinterval (and thus be medicament dependent); if, for example, a doseshould not be taken more frequently than every 20 hours, the “early”region will extend from t=0 to at least t=20; similarly, if a gap of nomore than 28 hours is allowable between consecutive doses, the “late”region will extend from t=28 onwards (the “late” region displaying, say,t=35+, where the “+” indicates that the currently elapsed time could bein excess of 35 hours).

The embodiment shown in FIGS. 8 a-8 e can be modified so as to besuitable for each of the twice, thrice and four times a day regimens:where a regimen involves an increasing number of doses, the regionscorrespond to shorter time periods. Thus, referring to FIGS. 9 a and 9b, for the four times a day regimen, the early region 901 a could extendbetween t=0 and t=5 hours, while the due region 901 b could correspondto t=5 to t=7 hours and the late region 901 c could correspond to t=7 tot=12+ hours.

Advantageously medicament dispensers can be manufactured as commercialoff the shelf dispensers, each corresponding to a specific regimen, andnot requiring programming in accordance with specific regimens. Thismeans that cheaper dispensers can be made and a physician can simplyprescribe whichever dispenser is appropriate for the user's medicationand regimen, thereby removing the need to perform any additional stepsin dependence on type of medicament (such as reading information fromthe medicament and programming the dispenser to present an alert state).

FIGS. 10 a, 10 b, 10 c and 10 d show display modes corresponding to athird embodiment, which can be used for both the once and twice a dayregimens. In these figures the display mode is shown without thebackdrop of the screen 22; (from the earlier figures the skilled personwould appreciate that the display modes could, for example, be presentedon the left hand side of the screen 22, or around the periphery of thescreen 22). Referring firstly to FIG. 10 a, a first display modecontaining region 1001 a indicates an early stage for both regimens;referring to FIG. 10 b, a second display mode including region 1001 bindicates a “dose due” stage for the twice a day regimen and an “early”stage for the once a day regimen. In the event that a user is on thetwice a day regimen, and they take a dose during the time correspondingto this second display mode, the dispenser will automatically revert tothe first display mode (showing region 1001 a). Thus in the event that atwice daily user always takes the dose during the “dose due” stage, thedispenser will not operate in any more than the first two display modes.

Referring to FIG. 10 c, and assuming that the user has not taken a dose,then when the elapsed time exceeds 15 hours, a third display modeincluding region 1001 c will be activated, indicating a “late” stage forthe twice a day regimen and a “dose due” stage for the once a dayregimen. Assuming that the user does not take a dose while the thirddisplay mode is activated, the dispenser will ultimately display adisplay mode containing region 1001 d, indicating a late stage for bothregimens (FIG. 10 d). As for the second embodiment, a display mode cansimply comprise whichever region 1001 a-1001 d corresponds to thecurrent stage of elapsed time.

In this third embodiment, the duration corresponding to a respectiveregion 1001 a, 1001 b, 1001 c, 1001 d is dependent on features of bothregimens: the upper limit t_(1003a) of region 1001 a is set tot_(1003a)<t_(dose due for 2× regimen), and may, for example be set to 9hours; the upper limit t_(1003b) of region 1001 b is then set to a timethat falls later than the time at which a dose is due for the twice aday regimen and earlier than the time at which a dose is due for theonce a day regimen, i.e.t_(dose due for 2× regimen)<t_(1003b)<t_(dose due for 1× regimen) andmay, for example, be set to 15 hours; and the upper limit t_(1003c) ofregion 1001 c is set to a time that falls later than the time at which adose is due for the once a day regimen, i.e.t_(1003c)>t_(dose due for 1× regimen) and may, for example, be set to 30hours. These times t_(1003a), t_(1003b), t_(1003c) will be dependent onthe sensitivity to a deviation from the time at which the next dose isdue, as described above. The upper limit t_(1003d) of region 1001 d canbe set to an arbitrary number of hours in excess of 28 hours, e.g. 40+hours.

In the event that each region is assigned a different colour (e.g.region 1001 a is orange; region 1001 b is blue; region 1001 c is red andregion 1001 d is green), the physician can instruct the user as to whichcolour indicates that his dose is due (e.g. if on a twice daily regimen,the due region could be blue, and if on a once a day regimen, the dueregion could be red), and which colour region(s) indicates an early or alate stage of elapsed time. The physician may, for example, place acoloured sticker on the cover 10 corresponding to the colour of theappropriate “due” region.

This third embodiment is particularly advantageous from a manufacturingpoint of view, since the same dispenser can be used for two differentregimens and, as for the embodiment described with reference to FIGS. 8a-8 e, no additional programming is required, so the dispenser can berelatively simple and cheap. This embodiment can also be applied to boththe thrice and four times a day regimens (but the time periodscorresponding to the regions, defined by t_(1003a), t_(1003b), t_(1003c)and t_(1003d) will be determined by the constraints of the thrice andfour times a day regimens).

In a further arrangement, one, some, or all extents 1003 a, 1003 b, 1003c, 1003 d of the regions can be set manually, by a user, via aconfigurable timing device (not shown) that is connected to the controlunit 90. This means that the same dispenser could be used for allregimes.

FIGS. 11 a, 11 b, 11 c and 11 d, 11 e show display modes according to afourth embodiment, which can be used for the once, twice, thrice andfour times a day regimens. As for the third embodiment, these figuresare enlarged and presented without the backdrop of the screen 22 forclarity. Referring to FIG. 11 a, a first display mode involvesdisplaying region 1101 a for an elapsed time of between 0 and 5 hours;this corresponds to an “early” stage of elapsed time in respect of allof the regimens. A second display mode involves displaying region 1101 bfor an elapsed time of between 5 and 10 hours; this corresponds to an“early” stage of elapsed time in respect of the once and twice dailyregimes and a “dose due” stage of elapsed time in respect of the thriceand four times a day regimens (since for the thrice a day regimen a doseis due at 8 hours, and for the four times a day regimen a dose is due at6 hours). In the event that a user is on either of these regimens, andhe takes a dose during a time corresponding to this second display mode,the dispenser will automatically revert to the first display mode 1101a. Thus in the event that a thrice daily or four times a day user alwaystakes the dose during the “dose due” stage, the dispenser will notoperate in any more than the first two display modes.

Turning now to FIG. 11 c, a third display mode involves displayingregion 1101 c for an elapsed time of between 10 and 19 hours; thiscorresponds to a “dose due” stage of elapsed time in respect of thetwice daily regime, an “early” stage of elapsed time in respect of theonce daily regimen and a “late” stage of elapsed time in respect of thethrice daily and four times a day regimens. In the event that a user ison the twice a day regimen, and he takes a dose during a timecorresponding to this third display mode, the dispenser willautomatically revert to the first display mode 1101 a. Thus in the eventthat a twice daily user always takes the dose during the “dose due”stage, the dispenser will not operate in any more than the first threedisplay modes.

Turning now to FIG. 11 d, a fourth display mode involves displayingregion 1101 d for an elapsed time of between 19 and 25 hours; thiscorresponds to a “dose due” stage of elapsed time in respect of the oncedaily regimen and a “late” stage of elapsed time in respect of thetwice, thrice daily and four times a day regimens. In the event that auser is on the once a day regimen, and he takes a dose during a timecorresponding to this fourth display mode, the dispenser willautomatically revert to the first display mode 1101 a. Thus in the eventthat a once a day user always takes the dose during the “dose due”stage, the dispenser will not operate in any more than the first fourdisplay modes. Turning finally to FIG. 11 e, a fifth display modeinvolves displaying region 1101 e for an elapsed time in excess of 25hours. This corresponds to a “late” stage of elapsed time in respect ofall of the regimens.

The period of time corresponding to region 1101 c in the third displaymode—the “dose due” stage for the twice a day regimen—is relativelylong; if the twice a day regimen user were to take a dose towards theend of this period, this may lead to unsafe deviations from the twice aday regimen. Thus, in an alternative arrangement, the fourth embodimentcould involve shortening the period corresponding to region 1101 c tobetween 10 and 15 hours and displaying a further display mode for anelapsed time of between 15 and 20 hours; this further mode, which isactivated at 15 hours instead of 19 hours, would correspond to an“early” stage of elapsed time in respect of the once daily regimen, anda “late” stage of elapsed time in respect of the twice, thrice daily andfour times a day regimens. Thus, none of the regions in this displaymode correspond to “dose due”, meaning that this further display modewould not serve the purpose of prompting the user to take a dose.However, it would serve the purpose of reducing the deviation from theideal spacing between successive doses on a twice a day regimen, sincethe user would know that he is in a “late” stage of elapsed time soonerthan is possible with the arrangement shown in FIG. 11 c.

This fourth embodiment is especially advantageous from a manufacturingpoint of view, since the same dispenser can be used for four differentregimens and, as for the embodiment described with reference to FIGS. 8a-8 e, no additional programming is required, so the dispenser can berelatively simple, and thus cheap. This embodiment is also relativelystraightforward from a user point of view: when prescribing thedispenser, the physician would merely have to instruct the userregarding the display mode that is relevant to the user's regime. In theevent that the regions are of different colours (e.g. region 1101 aorange; region 1101 b blue; region 1101 c red; region 1101 d green;region 1101 e yellow; and region 1101 f mauve), the physician wouldidentify whichever colour corresponds to the “dose due” stage for theuser's regimen and instruct the user to take a dose when the display 22shows that colour (optionally placing a sticker of the appropriatecolour on the cover 10, as described above). The physician couldadditionally indicate the colour of the “early” stage of elapsed time,and when more than one region corresponds to “early” stage (as is thecase for, e.g. the once a day regimen), the physician could simplyindicate the colour of the region immediately preceding the “dose due”region. This would enable the user to prepare for the fact that a dosewill fall due shortly. Conversely, the physician could indicate thecolour of the region that corresponds to one or more “late” stages.

A fifth embodiment of the invention is shown in FIGS. 12 a-12 f, whichcorrespond to FIGS. 11 a and 11 b of the fourth embodiment, with theaddition of gradations indicative of the proportion of time, within aregion, that has elapsed. Thus referring to FIGS. 12 a-12 c, during thefirst display mode, while region 1101 a is displayed, between 0 and 1.67hours, a first gradation mark 1201 a is also displayed; between 1.67hours and 3.23 hours, a second gradation mark 1201 b is displayed; andbetween 3.23 hours and 5 hours a third gradation mark 1201 c isdisplayed. Referring to FIGS. 12 d and 12 e, during the second displaymode, while region 1101 b is displayed, between 5 and 6.67 hours afourth gradation mark 1203 a is displayed; between 6.67 hours and 8.23hours a fifth gradation mark 1203 b is displayed; and between 8.23 hoursand 10 hours a sixth gradation mark 1203 c is displayed. It will beappreciated that the number of gradations is a design choice that isdependent on, for example, the constraints of the display 22 and medicalconstraints.

An advantage of this embodiment is that a user can see amount of timethat has elapsed to a greater degree of accuracy than is possible withthe previous embodiments, which can be useful in minimising irregularityin inter-dose intervals. This embodiment is particularly useful in thecontext of the fourth embodiment, where the second display modecorresponds to the “dose due” stage for both the third and fourthregimens, since it enables the user to differentiate the time that adose is due for the thrice a day regimen (fifth gradation 1203 b) fromthe time that a dose is due for the four times a day regimen (fourthgradation 1203 a).

A sixth embodiment is now described, with reference to FIGS. 13 a-13 c,for an alternative arrangement wherein the display modes are presentedaround the periphery of the display 22. In this sixth embodiment,regimen information associated with the refill cassette 30 is utilised.Referring back to FIG. 4, the refill cassette 30 includes a memory chip108, which is in data communication with the control unit 90 via a datacommunication interface 110. The control unit 90 uses a timing regimen,which may be preset in the control unit 90 or read from the memory chip108, to determine the length of time between dose reminders. If thecurrent elapsed time since the taking the last dose is less than orgreater than the dose reminder interval, a dose not due or a dose duecondition is generated by the control unit 90, causing respectively“dose not due” indicia 1305 a or “dose due” 1305 b to be displayed onwhichever region corresponds to the currently elapsed time.

This embodiment will now be exemplified using the once a day regimenshown in FIGS. 8 a, 8 b and 8 c, assuming that the dose reminderinterval read from the chip 108 is 24 hours. During the “early” stage ofelapsed time, the first display mode is activated (displaying region1301 a) and the “dose not due” indicium 1305 a is displayed. When thecurrently elapsed time reaches 20 hours, the second display mode, thusregion 1301 b, is activated (shown in FIG. 13 b). When the currentlyelapsed time reaches 24 hours, the display mode is modified to include“dose due” indicium 1305 b; preferably, the dose due indicium 1305 b isalternately switched on and off to highlight to the user that their doseis due. In the event that the currently elapsed time exceeds the dosereminder interval, and the control unit 90 detects that no dose has yetbeen taken, the control unit 90 proceeds as per the second embodiment,activating the third display mode when the elapsed time reaches 28hours. In this situation, the third display mode can include the “dosedue” indicium, as shown in FIG. 13 c, or alternatively “late dose”indicium 1305 c, which may flash intermittently.

FIGS. 14 a-14 e show a seventh embodiment of the invention, whichinvolves use of a bezel 40. The bezel 40 is removably connected to theholder 20 via lugs 41 a, 41 b, 41 c (41 c not shown), which engage in agroove (not shown) in holder 20, the groove being located above thedisplay 22. The bezel 40 has a transparent annular portion 41 locatedbetween limiters A1, A2, while the remainder of the annulus (portion 42)is obscured. As can be seen from FIG. 14 b, the transparent portion 41is dimensioned such that, when connected to the holder 20 via the clips41 a, 41 b, 41 c, parts of the display underneath the annular portion 41can be seen while parts under the obscured portion 42 cannot.Conveniently the bezel 40 can assume a plurality of positions, ororientations with respect to the display, since the groove in the holder20 can extend around the whole outer perimeter of the display 22,enabling lugs 41 a, 41 b, 41 c to engage at any position in the groove.Alternatively the holder 20 can have a plurality of grooves of aspecified length, each groove corresponding to one of the lugs 41 a, 41b, 41 c.

FIGS. 14 c, 14 d, 14 e show the bezel in three different positions,respectively corresponding to a thrice, twice and once a day regimen,superimposed upon display 22. As for the first embodiment, the displayindicia includes a plurality of separately activatable regions 1401 a .. . 1401 l, which each separately indicates a further period that haselapsed since the time of last taking a dose. In this configuration,each region corresponds to a period of 2 hours, and each region 1401 a .. . 1401 l is activated upon passage of a further 2 hours. Referringfirstly to FIG. 14 c, for the thrice a day regimen, the bezel 40 ispositioned such that the annular portion 41 is laid over regions 1401 cthrough 1401 f, meaning that all portions except 1401 c through 1401 fare obscured from view (the cross-hatch of regions 1401 a, 1401 bindicates that, despite being activated, these regions cannot be seenwith the bezel 40 in place). In the event that the user takes the dosewhile regions 1401 c . . . 1401 f are activated, the control unit 90will automatically reset the clock, thereby activating region 1401 a(which will of course be unseen). Referring next to FIG. 14 d, for thetwice a day regimen, the bezel is positioned such that the annularportion 41 is laid over regions 1401 e through 1401 h, meaning that allportions except 1401 e through 1401 h are obscured from view; in theevent that the user takes the dose while regions 1401 e . . . 1401 h areactivated, the control unit 90 will automatically reset the clock,thereby activating region 1401 a. Referring next to FIG. 14 e, for theonce a day regimen, the bezel is positioned such that the annularportion 41 is laid over regions 1401 i through 1401 l, meaning that allportions except 1401 i through 1401 l are obscured from view; in theevent that the user takes the dose while regions 1401 i . . . 1401 l areactivated, the control unit 90 will automatically reset the clock,thereby activating region 1401 a.

An advantage of this embodiment is that the same medicament dispenserand bezel can be used irrespective of regimen; the bezel 40 simply hasto be positioned in an appropriate position with respect to the display22 (e.g. by a physician), and the user instructed to take a dose whenhe/she sees a region being activated.

An eighth embodiment is now described with reference to FIGS. 15 a-15 d.In this embodiment, the screen 22 includes arrow indicium 1511, which ispreferably formed from static indicia, and an opaque cover 1521 that ispositioned so as to obscure an arcuate annular portion of the display22, leaving portion 1531 visible. The indicia 1501 a, 1501 b, 1501 c aredistributed over the obscured and visible portions, and rotate, asindicated by arrow 1541, around the display 22. Thus their positions,within these sections, change over tine, and different indicia 1501 a,1501 b, 1501 c align with the arrow 1511 at different times. In onearrangement the display mode changes discretely such that the firstdisplay mode, involving displaying region 1501 a in portion 1531, isactivated during the “early” stage of elapsed time; the second displaymode, involving displaying region 1501 b in portion 1531, is activatedduring the “dose due” stage of elapsed time; and the third display mode,involving displaying region 1501 c in portion 1531, is activated duringthe “late” stage of elapsed time. Alternatively the display mode canchange continuously, meaning that the rotation of the indicia correlateswith real time; this means that, at certain times, the arrow 1511 can beexpected to align with what appears to be a transition between thedisplay modes (as shown in FIG. 15 d). This arrangement is particularlyuseful to the user since it enables him to see the proportion of timethat has elapsed within a stage, and is an alternative to the fifthembodiment.

A ninth embodiment will now be described, with reference to FIGS. 16a-16 d. In this embodiment the display 22 includes an arrow indicium1611 and annular display region 1621, and activation of a display modeinvolves rotation of the annular display region 1621. Preferably theregions 1601 a, 1601 b, 1601 c, 1601 d are static indicia, which, asannular region 1621 rotates relative to the screen 22, rotate (indicatedby movement arrow 1641) relative to the arrow indicium 1611. Operationof this embodiment will now be described for a medicament dispenser thatis configured for both the once a day and twice a day regimens. After adose has been taken, the first display mode (“early” stage of elapsedtime for both regimens) is activated (FIG. 16 a), involving alignment ofregion 1601 a with the arrow indicium 1611. As the elapsed timeincreases, the second display mode, which relates to an “early” stage ofelapsed time for the once a day and “dose due” stage of elapsed time forthe twice a day regimen, is activated, involving alignment of region1601 b with the arrow indicium 1611 (FIG. 16 b). Assuming a dose is nottaken, the third display mode, which relates to an “dose due” stage ofelapsed time for the once a day and “late” stage of elapsed time for thetwice a day regimen, is subsequently activated, resulting in alignmentof region 1601 c with the arrow indicium 1611 (FIG. 16 c). Assuming adose is not taken, the fourth display mode, which relates to a “late”stage of elapsed time for both regimens, is activated, involvingalignment of region 1601 d with the arrow 1611 (FIG. 16 d). In order torotate the display region 1621, the holder 20 could include a motorcoupled to the control unit 90, which would be arranged to move thedisplay region 1621 in the manner described above.

FIGS. 8 a to 16 d illustrate use of the display configuration shown inFIG. 5 to present various alert states to a user. In one arrangement thedisplay is not activated unless opening of the cover 10 is sensed(sensor 94), thereby reducing the power consumption of the batterywithin the base unit. In this arrangement, when the cover 10 is opened,the cover open sensor 94 senses the opening of the cover, and inresponse control unit 90 displays the current operating conditions ofthe medicament dispenser on the display 22. After a preset period ofinactivity by the user, the display may again be powered down.Alternatively, and if there is sufficient battery power, the display maybe permanently activated; this can simplify the electronic subsystem ofthe dispenser.

Note that although not illustrated in FIGS. 5 to 16 d, the electronicsubsystem may also include other forms of indicators, such as an audiblealarm generator, which may be used, alone or in combination with visualdisplay on the display, to indicate an alert state. For example, when analert state includes a region corresponding to a “dose due” stage ofelapsed time, the medicament dispenser may provide an audible alarm atintervals which increase in frequency and/or volume whilst the dose duecondition remains. Alternatively, the control unit 90 may presentindicia at different alert rates—e.g. in the form of flashing LightEmitting Diodes (LED) or display elements in the display 22—independence on the stage of elapsed time. When an alert state includes aregion corresponding to “late” stage of elapsed time, the control unit90 could be arranged display the late region intermittently, in anattempt to attract the user's attention.

In the above, the display 22 takes the form of a segmented LCD display.In a segmented LCD display, the display indicia are formed by means ofindividual liquid crystal elements which are preconfigured in thedisplay screen, and which may be separately activated under the controlof the control unit 90. An advantage of using a segmented display isincreased clarity, along with reduced cost. The display may bemonochrome or colour. Again, for increased clarity and reduced cost, amonochrome display is preferred. The display may take other forms, forexample, comprise a screen such as an LED arrangement or a pixellatedLCD display. The display may be embodied using analogue or digitaltechnology.

Whilst the memory chip 108 is described as communicating with thecontrol unit 90 via electrical contacts, the memory chip 108 may be inthe form of a radio frequency (RFID) tag, and the data communicationsinterface 110 may be a wireless data communications interface.

In the above, detectors are used to sense a condition of the medicamentdetector. However, any actuation detector or release detector thatcomprises a sensor for detecting any suitable parameter such as movementcould be used. Any suitable sensors are envisaged including the use ofoptical sensors and electrical contact switches. The release detectormay sense any parameter affected by release of the medicament such aspressure, temperature, sound, moisture, carbon dioxide concentration andoxygen concentration.

A medicament dispenser according to the invention is suitable fordispensing medicament, particularly for the treatment of respiratorydisorders such as asthma and chronic obstructive pulmonary disease(COPD).

Appropriate medicaments may thus be selected from, for example,analgesics, e.g., codeine, dihydromorphine, ergotamine, fentanyl ormorphine; anginal preparations, e.g., diltiazem; antiallergics, e.g.,cromoglycate (e.g. s the sodium salt), ketotifen or nedocromil (e.g. asthe sodium salt); antiinfectives e.g., cephalosporins, penicillins,streptomycin, sulphonamides, tetracyclines and pentamidine;antihistamines, e.g., methapyrilene; anti-inflammatories, e.g.,beclomethasone (e.g. as the dipropionate ester), fluticasone (e.g. asthe propionate ester), flunisolide, budesonide, rofleponide, mometasonee.g. as the furoate ester), ciclesonide, triamcinolone (e.g. as theacetonide) or6α,9α-difluoro-11β-hydroxy-16α-methyl-3-oxo-17α-propionyloxy-androsta-1,4-diene-17β-carbothioicacid S-(2-oxo-tetrahydro-furan-3-yl)ester; antitussives, e.g.,noscapine; bronchodilators, e.g., albuterol (e.g. as free base orsulphate), salmeterol (e.g. as xinafoate), ephedrine, adrenaline,fenoterol (e.g. as hydrobromide), formoterol (e.g. as fumarate),isoprenaline, metaproterenol, phenylephrine, phenylpropanolamine,pirbuterol (e.g. as acetate), reproterol (e.g. as hydrochloride),rimiterol, terbutaline (e.g. as sulphate), isoetharine, tulobuterol or4-hydroxy-7-[2-[[2-[[3-(2-phenylethoxy)propyl]sulfonyl]ethyl]amino]ethyl-2(3H)-benzothiazolone;adenosine 2 a agonists, e.g.2R,3R,4S,5R)-2-[6-Amino-2-(1S-hydroxymethyl-2-phenyl-ethylamino)-purin-9-yl]-5-(2ethyl-2H-tetrazol-5-yl)-tetrahydro-furan-3,4-diol(e.g. as maleate); α₄ integrin inhibitors e.g.(2S)-3-[4-({[4-(aminocarbonyl)-1-piperidinyl]carbonyl}oxy)phenyl]-2-[((2S)-4-methyl-2-{[2-(2-methylphenoxy)acetyl]amino}pentanoyl)amino] propanoic acid (e.g. as free acid or potassium salt), diuretics,e.g., amiloride; anticholinergics, e.g., ipratropium (e.g. as bromide),tiotropium, atropine or oxitropium; hormones, e.g., cortisone,hydrocortisone or prednisolone; xanthines, e.g., aminophylline, cholinetheophyllinate, lysine theophyllinate or theophylline; therapeuticproteins and peptides, e.g., insulin or glucagon; vaccines, diagnostics,and gene therapies. It will be clear to a person skilled in the artthat, where appropriate, the medicaments may be used in the form ofsalts, (e.g., as alkali metal or amine salts or as acid addition salts)or as esters (e.g., lower alkyl esters) or as solvates (e.g., hydrates)to optimise the activity and/or stability of the medicament.

Preferred medicaments are selected from albuterol, salmeterol,fluticasone propionate and beclomethasone dipropionate and salts orsolvates thereof, e.g., the sulphate of albuterol and the xinafoate ofsalmeterol.

Medicaments can also be delivered in combinations. Preferredformulations containing combinations of active ingredients containsalbutamol (e.g., as the free base or the sulphate salt) or salmeterol(e.g., as the xinafoate salt) or formoterol (e.g. as the fumarate salt)in combination with an antiinflammatory steroid such as a beclomethasoneester (e.g., the dipropionate) or a fluticasone ester (e.g., thepropionate) or budesonide. A particularly preferred combination is acombination of fluticasone propionate and salmeterol, or a salt thereof(particularly the xinafoate salt). A further combination of particularinterest is budesonide and formoterol (e.g. as the fumarate salt).

Generally, powdered medicament particles suitable for delivery to thebronchial or alveolar region of the lung have an aerodynamic diameter ofless than 10 micrometers, preferably less than 6 micrometers. Othersized particles may be used if delivery to other portions of therespiratory tract is desired, such as the nasal cavity, mouth or throat.The medicament may be delivered as pure drug, but more appropriately, itis preferred that medicaments are delivered together with excipients(carriers) which are suitable for inhalation. Suitable excipientsinclude organic excipients such as polysaccharides (i.e. starch,cellulose and the like), lactose, glucose, mannitol, amino acids, andmaltodextrins, and inorganic excipients such as calcium carbonate orsodium chloride. Lactose is a preferred excipient.

Particles of the powdered medicament and/or excipient may be produced byconventional techniques, for example by micronisation, milling orsieving. Additionally, medicament and/or excipient powders may beengineered with particular densities, size ranges, or characteristics.Particles may comprise active agents, surfactants, wall formingmaterials, or other components considered desirable by those of ordinaryskill.

The excipient may be included with the medicament via well knownmethods, such as by admixing, co-precipitating and the like. Blends ofexcipients and drugs are typically formulated to allow the precisemetering and dispersion of the blend into doses. A standard blend, forexample, contains 13000 micrograms lactose mixed with 50 microgramsdrug, yielding an excipient to drug ratio of 260:1. Dosage blends withexcipient to drug ratios of from 100:1 to 1:1 may be used. At very lowratios of excipient to drug, however, the drug dose reproducibility maybecome more variable.

It will be understood that the present disclosure is for the purpose ofillustration only and the invention extends to modifications, variationsand improvements thereto, and that any elements of the differentembodiments may be combined to form further embodiments of theinvention.

Note that, in other applications of the invention, the base unit, refillcontainer and/or medicament carrier may take a variety of differentforms. Correspondingly, the icons or other graphical representationsused may similarly take a variety of different forms. The invention maybe used for purposes other than informing a taker of medicament; forexample the display functionality may be used for training purposes andfor informing and/or warning caregivers.

In the foregoing embodiments an event relating to the dispensing ofmedicament is detected by means of movement of the index wheel 60 or bydetection of scattered radiation by inhalation sensor 106. However, thedetector can be provided by other means, based on events that areindicative of usage of the dispenser. These events include opening thecover 10, changes in flow rate and changes in pressure through themouthpiece 36, so that other suitable detectors include a cover-movementdetector and a pressure measuring device arranged to measure static anddynamic pressure (e.g. piezo electric crystal). In the case of themedicament dispenser being located in a holder until such time asmedication is to be dispensed, removal of the dispenser could also be anevent indicative of usage of the dispenser, in which case the detectorcan comprise a light emitter and detector pair located in the holder,which cooperatively provide a signal indicative of the presence, orremoval, of the dispenser from the holder.

Whilst in the foregoing description the embodiments have been describedas forming a part of a medicament dispenser, the alerting system(embodied in the control unit 90) could also be used in non-medicamentcontexts, since the alerting system essentially provides support for anyevents that involve usage of a device and that have to be performed on aregular basis, where the regularity is defined with respect to aprevious event. For example, the alerting system could be used inconjunction with an electric toothbrush, where an action indicative ofusage of a device comprises, e.g., removing the toothbrush from itsholder.

The application of which this description and claims form part may beused as a basis for priority in respect of any subsequent application.The claims of such subsequent application may be directed to any featureor combination of features described therein. They may take the form ofproduct, method or use claims and may include, by way of example andwithout limitation, one or more of the appended claims.

1. An alerting system for use in generating an alert in respect of usageof a device, the alerting system including a detector capable ofdetecting an event that is indicative of usage of the device, thealerting system being arranged to invoke a selected alert state prior tothe activation of a forthcoming said event by a user, the alert statebeing selectable from a plurality of different alert states, whereineach of the different alert states represents a different stage ofelapsed time since a previous said event, and wherein the alertingsystem is arranged to select an alert state in dependence on the elapsedtime characterized in that at least one alert state comprises aplurality of sub-regions, each sub-region representing a proportion ofelapsed time within the stage to which the alert state corresponds. 2.An alerting system according to claim 1, wherein at least one alertstate represents a length of time in excess of 2 hours.
 3. An alertingsystem according to claim 1, wherein at least one alert statecorresponds to a period that includes an elapsed time of 24 hours.
 4. Analerting system according to claim 1 wherein at least one alert statecorresponds to a period that includes an elapsed time in excess of 24hours.
 5. An alerting system according to claim 1, including at leasttwo alert states, wherein the alert states include a first alert statecorresponding to a period which includes an elapsed time of 24 hours anda second alert state corresponding to a period which includes an elapsedtime of 12 hours.
 6. An alerting system according to claim 1, wherein atleast one alert state represents a different length of time to thatrepresented by at least one of the other alert states or thatrepresented by the other alert state.
 7. An alerting system according toclaim 1, wherein an alert state is visually distinct from each otheralert state.
 8. An alerting system according to claim 7, wherein eachalert state has a different color, or configuration of colors,associated therewith.
 9. An alerting system according to claim 1,wherein the alerting system is arranged to select an alert state independence on a relationship between the elapsed time and a time atwhich said forthcoming event is due.
 10. An alerting system according toclaim 9, wherein, in the event that the currently elapsed time is lessthan a specified amount of time before the time at which saidforthcoming event is due, the alerting system is arranged to select analert state that includes indicia indicative of inaction.
 11. Analerting system according to claim 9, wherein, in the event that thecurrently elapsed time is within a specified amount of time from thetime at which said forthcoming event is due, the alerting system isarranged to select an alert state that includes indicia indicative ofaction.
 12. An alerting system according to claim 9, wherein, in theevent that the currently elapsed time is greater than a specified amountof time after the time at which said forthcoming event is due, thealerting system is arranged to select an alert state that includesindicia indicative of action.
 13. An alerting system according to claim1, wherein the alerting system is operable to present the alert statesat different alert rates, each alert rate representing a different stageof the elapsed time.
 14. An alerting system according to claim 13,including at least one light emitting part operatively connectedthereto.
 15. An alerting system according to claim 13, including atleast one sound emitting part operatively connected thereto.
 16. Analerting system according to claim 1, wherein an alert state comprises adisplay mode having one or more regions each representing a differentstage of the elapsed time.
 17. An alerting system according to claim 16,wherein at least one region represents a different length of time tothat represented by at least one of the other regions or thatrepresented by the other region.
 18. An alerting system according toclaim 16, wherein at least one region represents the same length of timeto that represented by at least one of the other regions or thatrepresented by the other region.
 19. An alerting system according toclaim 1, including a sensor arranged to detect said event and a timerarranged to record elapsed time from the detected event.
 20. An alertingsystem according claim 1, wherein the alerting system is arranged toselect a default alert state in response to a newly detected event. 21.An alerting system according claim 1, wherein the alerting systemcomprises a segmented display.
 22. A medicament dispenser capable ofdetecting an event relating to the dispensing of medicament, comprisingan alerting system according to claim
 1. 23. A medicament dispenseraccording to claim 22, wherein the dispenser comprises an inhalationdevice adapted either for oral or nasal use.
 24. A method of using amedicament dispenser comprising the steps of: (a) providing a medicamentdispenser according to claim 22 and (b) dispensing medicament from saidmedicament dispenser in response to an alert from said alerting system.25. A medicament dispenser capable of detecting an event relating to thedispensing of medicament, wherein the dispenser is responsive to elapsedtime since a previous said event, the dispenser comprising an alertingsystem arranged to invoke a selected alert state prior to the activationof a next said event by the user, the alert state being selectable froma plurality of different alert states, each of the different alertstates representing a different stage of elapsed time, wherein thedispenser is arranged to select an alert state in dependence on theelapsed time.